Provider Demographics
NPI:1205171618
Name:GORDON L LEVIN MEDICAL CORP
Entity type:Organization
Organization Name:GORDON L LEVIN MEDICAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:LEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:408-356-4774
Mailing Address - Street 1:14901 NATIONAL AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2637
Mailing Address - Country:US
Mailing Address - Phone:408-356-4774
Mailing Address - Fax:408-356-8072
Practice Address - Street 1:14901 NATIONAL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2637
Practice Address - Country:US
Practice Address - Phone:408-356-4774
Practice Address - Fax:408-356-8072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG17837207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG178370Medicaid
CA1427085745OtherNPI
CAA40205Medicare UPIN